Somma Teresa, Maraolo Alberto Enrico, Esposito Felice, Cavallo Luigi Maria, Tosone Grazia, Orlando Raffaele, Cappabianca Paolo
Department of Neurosciences, Reproductive and Odontostomatological Sciences, Division of Neurosurgery - Università degli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy.
Department of Clinical Medicine and Surgery, Section of Infectious Diseases - Universitàdegli Studi di Napoli Federico II, Via Sergio Pansini 5, 80131 Napoli, Italy.
Clin Neurol Neurosurg. 2015 Dec;139:206-9. doi: 10.1016/j.clineuro.2015.10.007. Epub 2015 Oct 13.
The study aims to evaluate the incidence of infectious complications (namely meningitis) within 30 days after endoscopic endonasal transspheinodal neurosurgery (EETS) in patients receiving an ultra-short peri-operative chemo-prophylaxis regimen with 2 doses of 1st generation cephalosporin or macrolide.
We retrospectively analyzed the clinical records of 145 patients who received an ultra-short chemoprophylaxis with two doses of an antibiotic, given 30 min before and 8h after EETS, over a 30-month time-frame. Ninety-seven patients (66.89%) received endovenous cefazolin, a 1st generation cephalosporin, administered at a dosage of 1000 mg, and 48 patients (33.10%) with an history of allergy to various agents, received endovenous clarithromycin at a dosage of 500 mg.
No case of peri- and post-operative meningitis occurred in patients receiving the 2 doses of antibiotic. Only one patient (0.68%) developed cerebral fluid leakage on the 7th postoperative day, which required the switching to a broad-spectrum antibiotic prophylaxis for one week; this patient received the ultrashort prophylaxis with a macrolide. In addition, 7 patients (4.82%) developed minor infectious complications such as low-grade fever (3 cases, all of them receiving cefazolin), enlarged submandibular and cervical lymphnodes (3 cases, all of them receiving cefazolin), and upper and lower respiratory tract infection (1 case receiving clarithromycin). The cost of this prophylaxis regimen ranged from 7.76 Euro (cefazolin) to 39.54 Euro (clarithromycin).
This study suggested that an ultra-short single-antibiotic prophylaxis is a safe, cheap and effective regimen to prevent post-operative meningitis in patients undergoing EETS and who do not require lumbar drainage after surgery. In these patients also the rate of minor infective complications was acceptable when compared with the previous more expensive regimen based on 3rd generation cephalosporin plus aminoglycoside or alone, that could be suitable only for at-risk patients (e.g. smokers, cerebrospinal leak or Cushing's diseases).
本研究旨在评估接受超短围手术期化疗预防方案（两剂第一代头孢菌素或大环内酯类药物）的患者在内镜鼻内经蝶窦神经外科手术（EETS）后30天内感染并发症（即脑膜炎）的发生率。
我们回顾性分析了145例患者的临床记录，这些患者在30个月的时间范围内接受了超短化疗预防，在EETS前30分钟和术后8小时给予两剂抗生素。97例患者（66.89%）接受静脉注射头孢唑林，一种第一代头孢菌素，剂量为1000毫克，48例有多种药物过敏史的患者接受静脉注射克拉霉素，剂量为500毫克。
接受两剂抗生素的患者未发生围手术期和术后脑膜炎病例。仅1例患者（0.68%）在术后第7天出现脑脊液漏，需要改用广谱抗生素预防一周；该患者接受了大环内酯类药物的超短预防。此外，7例患者（4.82%）出现轻微感染并发症，如低热（3例，均接受头孢唑林）、颌下和颈部淋巴结肿大（3例，均接受头孢唑林）以及上、下呼吸道感染（1例接受克拉霉素）。这种预防方案的费用从7.76欧元（头孢唑林）到39.54欧元（克拉霉素）不等。
本研究表明，超短单抗生素预防方案是一种安全、廉价且有效的方案，可预防接受EETS且术后无需腰椎引流的患者发生术后脑膜炎。与之前基于第三代头孢菌素加氨基糖苷类药物或单独使用更昂贵的方案相比，这些患者的轻微感染并发症发生率也是可以接受的，之前的方案仅适用于高危患者（如吸烟者、脑脊液漏或库欣病患者）。
